Women with adjustment disorders who face fertility problems as part of a couple may have a higher risk of a poor prognosis in response to cognitive-behavioral therapy (CBT), a study in BMC Psychiatry suggests.
Mahbobeh Faramarzi, M.D., of Babol University of Medical Sciences in Babol, Iran, and colleagues conducted a secondary analysis based on a previous randomized, controlled trial of women with adjustment disorders who had received fertility treatments and were facing fertility problems as part of a couple.
The original study compared the efficacy of an internet cognitive behavioral program (ICBT) with face-to-face CBT for 152 women diagnosed with adjustment disorders who were facing the couple’s fertility problems. Treatment was offered in eight 50-minute individual sessions by two therapists, and follow-up took place at three and six months. The programs included psychoeducation, principles of CBT, restructuring techniques, behavioral techniques, changing schemas, and reviewing goals. The researchers defined adherence as receiving at least four of the eight sessions.
The researchers assessed the women’s mental health through measurements such as the Adjustment Disorder new Module-20, the Hospital Anxiety and Depression Scale, the Cognitive Therapy Awareness Scale, and the Automatic Thought Questionnaire. They defined nonresponse to treatment as less than a 50% reduction in the anxiety and depression total scores. Among the principal diagnoses, the prevalence of adjustment disorder with depressed mood was 37.5%, adjustment disorder with anxious mood was 21.7%, and adjustment disorder with mixed anxiety and depressed mood was 40.8%.
The secondary analysis revealed that women who had high anxiety and/or depression scores before beginning the CBT or ICBT programs had 1.4 to 2 times the risk of not responding to treatment compared with those whose scores were lower before beginning treatment. Women who did not respond to treatment were older and experienced higher levels of adjustment disorder, psychological distress, fertility adjustment problems, and infertility stress compared with women who had been responsive at the end of treatment and at the six-month follow-up. A lower education and longer marriage duration appeared to decrease the risk of nonresponse to treatment.
“The current research recommends early recognition and adequate treatment at the symptom onset for gaining a better response,” Faramarzi and colleagues wrote. “Therefore, these results not only encourage clinicians to use demographic and clinical variables in the early stages of treatment planning but also help track treatment response and patients’ perceptions of treatment.”
(Image: Getty Images/iStock/courtneyk)
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